This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Atherosclerotic renovascular disease is a recognized cause of severe secondary hypertension, progressive renal insufficiency, and end-stage renal disease among the elderly who make up the fastest growing subsegment of both the general and dialysis dependent populations. Angioplasty and stenting (PTAS) of the renal artery has shown beneficial effects with regards to blood pressure control. However, a low rate of beneficial renal function response has been observed. This limitation is critical as renal function response following renal revascularization has been demonstrated to be the major determinant of improved cardiovascular morbidity and mortality and survival free of dialysis dependence. The low rate of beneficial renal function response may be secondary to embolization of atheromatous debris liberated during PTAS. We hypothesize that renal embolization can be reduced through the use of a distal renal artery embolic protection device (DEP) and will improve the long-term benefits of renal artery PTAS. To test this hypothesis we propose a prospective, randomized clinical trial. The specific aims of this project will be 1) to examine the safety and efficacy of DEP to improve renal function response and blood pressure response following renal artery PTAS and 2) To characterize the atheromatous debris prevented from passage into the kidney using DEP.